<?php echo form_open_multipart('formdaftar_C/add_pegawai'); ?>
	
<table width='700' border='0'>
          <tr><td colspan=4><b><u>IDENTITAS PRIBADI</u></b></td></tr>
	<tr>
    <td width=3%>1.</td>
    <td width=30%>Nomor ID </td>
    <td width=2%>:</td>
    <td><input type=text required="required" name='no_id' size=3></td>
  </tr>
  
  	<tr>
    <td>2.</td>
    <td>Unit Bisnis </td>
    <td>:</td>
    <td><input type=text required="required" name='unit' size=3></td>
  </tr>
  
	<tr>
    <td>3.</td>
    <td>Nama Lengkap </td>
    <td width=2%>:</td>
    <td><input type=text required="required" name='nama_lengkap' size=77></td>
  </tr>
 
  <tr>
    <td>4.</td>
    <td>Tempat / Tgl. Lahir </td>
    <td>:</td>
    <td><input type=text name='tempat' size=20>    Tgl 
    
    <input  maxlength="2" type=text name='tgl' size=2>  Bln 
    <select name='bln'>
                  <option value="" selected='selected' >--Pilih Bulan--</option>
                  <option value=Januari>Januari</option>
				  <option value=Februari>Februari</option>
				  <option value=Maret>Maret</option>
				  <option value=April>April</option>
				  <option value=Mei>Mei</option>
				  <option value=Juni>Juni</option>
				  <option value=Juli>Juli</option>
				  <option value=Agustus>Agustus</option>
				  <option value=September>September</option>
				  <option value=Oktober>Oktober</option>
				  <option value=November>November</option>
				  <option value=Desember>Desember</option>
                  </select>
				  Tahun <input type=text maxlength="4" name='thn' size=5> </td>
  </tr>
   <tr>
    <td>5.</td>
    <td>Jenis Kelamin</td>
    <td>:</td>
    <td> <input name='kel' type='radio' value='M'/>Laki - laki
    <input name='kel'  type='radio' value='F'/>Perempuan
     </td>
  </tr>
  <tr>
    <td>6.</td>
    <td>Golongan Darah</td>
    <td>:</td>
    <td><input type=text required="required" name='darah' width="10 px"></td>
  </tr>
     <tr>
    <td>7.</td>
    <td>Pendidikan Terakhir </td>
    <td>:</td>
    <td><input type=text required="required" name='pendidikan' size='30'></td>
  </tr>
  <tr>
    <td>8.</td>
    <td>Nomor KTP </td>
    <td>:</td>
    <td><input type=text name='no_ktp' width="77 px"></td>
  </tr>
   <tr>
    <td>&nbsp;</td>
    <td>Nomor Paspor </td>
    <td>:</td>
    <td><input type=text name='no_paspor' width="77 px"></td>
  </tr>
   <tr>
    <td>&nbsp;</td>
    <td>Nomor NPWP</td>
    <td>:</td>
    <td><input type=text name='no_npwp' width="77 px"></td>
  </tr>
  <tr>
    <td>9.</td>
    <td>Alamat Sesuai KTP </td>
    <td>:</td>
    <td><textarea name="alamat_ktp"> </textarea></td>
  </tr>
    <tr>
    <td>10.</td>
    <td>Alamat Sesuai Domisili </td>
    <td>:</td>
    <td><textarea name="alamat_dom"> </textarea>
  </tr>
 
  <tr>
    <td>11.</td>
    <td>Telepon</td>
    <td>:</td>
    <td><input type=text name='t1' maxlength="4" size=5> <input type=text name='t2' size=10> Hp. <input type=text name='hp' maxlength="14" size=20></td>
  </tr>
  
  <td>12.</td>
    <td>Alamat E-mail </td>
    <td>:</td>
    <td><input type="email" spellcheck="false" width="77 px" ></td>
  </tr>
  <tr>
    <td>13.</td>
    <td>Rekening Bank No</td>
    <td>:</td>
    <td><input type=text name='no_rekening' size='77'></td>
  </tr>
     <tr>
    <td>&nbsp;</td>
    <td>Atas Nama</td>
    <td>:</td>
    <td><input type=text name='an' size='77'></td>
  </tr>
   <tr>
    <td>&nbsp;</td>
    <td>Nama Bank</td>
    <td>:</td>
    <td><input type=text name='nama_bank' size='77'></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>Cabang</td>
    <td>:</td>
    <td><input type=text name='cabang' size='77'></td>
  </tr>
  
    <tr>
    <td>14.</td>
    <td>Istri/Suami</td>
    <td>:</td>
    <td><input type=text name='bojo' size='77'></td>
  </tr>
    <tr>
    <td>&nbsp;</td>
    <td>Jumlah Anak</td>
    <td>:</td>
    <td><input type=text name='anak'></td>
  </tr>
 
  <tr><td></td><td align=right><input type=button value=Batal onclick=self.history.back()></td><td></td><td><input type=submit value=Simpan></td></tr>
	</table>
	</form>